One discussion this week involved the Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST).
Reference: Brott TG, et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. New England Journal of Medicine. 2010 Jul 1;363(1):11-23. doi:10.1056/NEJMoa0912321.
Summary: CREST is an RCT with blinded end-point adjudication whose aim was “to compare the outcomes of carotid-artery stenting with those of carotid endarterectomy among patients with symptomatic or asymptomatic extracranial carotid stenosis” (p.12).
Between December 2000 through July 2008, 2522 patients were enrolled in 108 centers in the US and 9 in Canada. Of those, 1271 patients were randomly assigned to undergo carotid-artery stenting.
Primary findings include (p.18):
- Carotid revascularization performed by highly qualified surgeons and interventionists is effective and safe.
- Stroke was more likely after carotid-artery stenting.
- Myocardial infarction was more likely after carotid endarterectomy, but the effect on the quality of life was less than the effect of stroke.
- Younger patients had slightly fewer events after carotid-artery stenting than after carotid endarterectomy.
- Older patients had few events after carotid endarterectomy.
- Low absolute risk of recurrent stroke suggests that both carotid-artery stenting and carotid endarterectomy are clinically durable and reflect advances in medical therapy.